He's a natural: baby whisperer promises birth policy shake-up

By Julie Robotham

THEY call him the baby whisperer. In the delivery room, Andrew Bisits is a hushed presence as he facilitates the daily miracle of natural birth.

Outside of it, he is about to get a lot noisier.

NSW is a "runaway birth machine that sees the need for intervention [at every turn]"... obstetrician Andrew Bisits with Lucinda Thurlow, a breech-birth baby he delivered.Credit:Jon Reid

Dr Bisits, the adored director of obstetrics in the Hunter region, is moving to Sydney's flagship Royal Hospital for Women, where he will help run its 4500-delivery-a-year birthing unit.

''I wanted to get closer to the action regarding birth policy in NSW,'' he said this week, describing the situation in NSW as a ''runaway birth machine that sees the need for intervention and risk management at every twist and turn of pregnancy and childbirth''.

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When he starts on October 5 he will bring a trio of potent philosophies: that birth is a process usually best left to women assisted by midwives; that many complicated births can progress naturally if allowed to; and that fear, fanned by the medical profession, leads many women to choose unnecessary caesarean deliveries.

NSW Health has already accepted the surgical birth rate - about 30 per cent - is too high, pledging to reduce it to 20 per cent over five years.

But the appointment of Dr Bisits, with his vocal support of midwives as the main birth professionals, fires a symbolic shot across the bows of his own profession. Obstetricians are engaged in a long-running turf war with midwives, as the federal government finalises terms under which the latter will be allowed to practise independently.

Dr Bisits will use his new prominence to discourage, ''excessive participation of obstetricians in low-risk births … The first birth is going to last longer. It shouldn't last forever but people are too ready to jump in … it imprints a whole pattern for the rest of the woman's childbearing career.''

Vaginal birth after a previous caesarean is achieved by only about 13 per cent of women, and a state target of 50 per cent has been set for 2015. He also offers vaginal delivery of twins, and - most famously - of the 3 to 4 per cent of babies, like 22-month-old Lucinda Thurlow, who remain in the breech position at full term.

Lucinda's mother, Rebecca, travelled from Sydney to Newcastle because Dr Bisits was the only doctor she could find to help her deliver naturally.

''I was out of hospital the same day and both of us were so well,'' Ms Thurlow said yesterday. ''I felt the birth helped with bonding and breastfeeding. Also I wanted to experience a natural birth. It's an important part of life.''

The president of the Australian College of Midwives, Hannah Dahlen, applauded Dr Bisits' appointment, saying he had ''chosen to go against obstetricians' main line. That makes him a very brave man. We desperately need wise, reasoned and evidence-based voices … to overcome the politics and the division'' around birth.

But an obstetrician at Westmead Hospital, Andrew Pesce, said supporting natural birth in more cases would not dramatically reduce the caesarean rate, and would be expensive.

In the public system, he said, it was ''a problem to match up the women with the sort of care they might need'' and hospitals would … need to have doctors willing to attempt complicated natural deliveries on-call at all times.

''The majority of women are reasonably happy with the care that's being given now.''

A NSW Health spokeswoman said an extra $42 million allocated over three years for maternity services would be used in part to boost ''skills required to support women in their choice of giving birth without technological interventions'', including turning badly positioned babies in the uterus.

Some hospitals would need extra doctors and midwives because of the policy, and the money could be used for this.